Supporting and Stabilizing the Health Care Workforce
National conversations about health care often focus on health care policy, care delivery and payment methods, and even patient experience. Less is said about the physicians, nurses, direct care workers and others who deliver care. The Alliance for Health Policy recently held a half-day summit that explored just that—the role of the health care workforce in the future of care delivery. The event, co-sponsored by Anthem, Inc., convened experts from provider, payer, policy and patient advocacy backgrounds to discuss avenues by which we can better support and stabilize the health and wellness of our health care workforce.
The health care workforce balances high volumes of patients, changing policies and rapidly evolving technologies – often all at once. Throughout the day, experts in three panels discussed possible solutions to these challenges, including additional continuing education for providers and adoption of team-based forms of medicine.
Delivery System Reform and Its Effect on the Health Care Workforce
In the first panel of the day, panelists from Novant Health, the Patient-Centered Care Collaborative and the Agency for Health Research and Quality examined how health care reform has created both challenges and opportunities for the workforce. Specifically, they examined the burden placed on providers in the form of new technologies, like EHRs; and new, quality-based care models that require a significant amount of time outside of patient visits to meet requirements.
Thomas Jenike, chief human experience officer at Novant Health, commented that while changes will eventually have a net positive effect, they have had an unfortunate side effect: physician burnout. As he put it, new requirements were not necessarily causing physicians to leave the field of health care, but instead to “[stay] and [quit] at the same time.” Jenike proposed his idea of the “Quadruple Aim,” which he defines as a way of measuring health care through quality, cost, accessibility and joy.
In order to achieve this goal, panelists discussed a variety of solutions, including providing training and support to develop team-based approaches to delivering care. In a team-based structure, administrative team members lessen the administrative burden on physicians and allow them to focus on their patients. Panelists also advocated for continued training on EHR systems and other evolving technologies to ease the headache of using these important, but sometimes complex systems.
The Behavioral Health Workforce
During the event’s second section, panelists from the Simmons School of Social Work at Simmons College, the National Alliance on Mental Illness (NAMI), and the National Council for Behavioral Health (NCBH) explored the state of the behavioral health care workforce. Panelists agreed that the key to lessening the burden on the behavioral workforce is to better integrate behavioral health with primary care. Andrew Sperling, director of legislative advocacy at NAMI, noted that “there’s more we can be doing to bring specialty behavioral health care into primary care settings.” Mohini Venkatash, vice president of practical improvement at NCBH, noted that requiring some degree of required training for all providers in identifying and treating mental illness and substance abuse issues could be a potential solution.
This is especially important given the interrelated nature of physical and mental health. For example, 69 percent of total antidepressant prescriptions in the U.S. are given by primary care physicians, not mental health specialists. Patients who have depression or anxiety also tend to have a harder time managing their physical conditions, like heart disease, arthritis, diabetes and others.
The panel also discussed how social determinants of health, like housing and availability of community-based supports, can impact the behavioral health workforce. They agreed that a person’s behavioral health is affected by more than treatment from his or her doctor and therapist—it is determined by a variety of people within their sphere of care, like nurses and care managers (if the patient is enrolled in a Medicaid managed care organization) and community systems. Integrated teams must therefore include broader caregivers and consider community supports. Dr. Peter Maramaldi, Hartford faculty scholar and national mentor at the Simmons School for Social Work, argued that social workers are a critical part of caring for at-risk populations, since these individuals can help with screening for behavioral health issues.
Caring for an Aging Population
The event’s final panel included participants from the U.S. Department of Veteran Affairs, the College of Medicine at Michigan State University and the Altarum Center for Elder Care and Advanced Illness. The panelists noted that the elder population is “the most overlooked, underserved minority group in health care,” and as the population continues to age it will only become more important to meet these patients’ needs.
Elderly care in the U.S. also faces unique challenges because the workforce consists not only of the traditional physicians and nurses, but also direct-care in-home workers and family caregivers. The panel focused on the latter two groups, who make up the majority of this workforce:
- Direct care workers are a critical part of caring for the aging, and panelists recommended increasing recognition for their roles in improving health outcomes, as well as increasing training for these workers.
- Family caregivers are often stretched too thin, with a middle generation often caring for aging parents and young children. Added to that, many family caregivers also have full time jobs, and the result is very high stress. Panelists advocated for more extensive paid family leave, which would enable these family caregivers to take time off without catastrophic financial repercussions.
Joanne Lynn, director at Altarum’s Center for Elder Care and Advanced Illness, emphasized the importance of solutions that consider “continuity of care” – team-based care systems that provide support to patients in the hospital, in recovery or rehabilitation centers and at home. Models like this, including Medicaid’s PACE, have been shown to significantly increase positive outcomes and reduce readmissions.
Education, training and team-based collaboration are three of the possible solutions to better support our health care workforce. Anthem has seen from experience that health care works best when all health care professionals are engaged to collaborate efficiently. Health plans can play a role by enhancing provider collaboration and guiding effective team-based health care. As the industry continues to change, one thing remains true: improving the experience of the health care workforce is critical to improving the quality of health care for everyone.